What are the recommended management options for sore throat symptoms?

Management of Sore Throat Symptoms

For sore throat symptom relief, either ibuprofen or paracetamol are recommended as first-line treatments, with ibuprofen showing slightly better efficacy for pain relief. 1, 2

First-Line Analgesic Options

• Ibuprofen and paracetamol are both effective for reducing acute sore throat symptoms, with strong evidence supporting their use 1, 2
• Ibuprofen appears to have slightly better efficacy than paracetamol for pain relief, particularly after 2 hours of administration 2, 3, 4
• Both medications are considered safe when used according to directions for short-term treatment of sore throat pain 2, 3
• NSAIDs like ibuprofen and naproxen are recommended for symptomatic treatment of sore throat 5

Treatment Algorithm

1. Initial assessment:

   • Rule out red flags such as immunosuppression and severe systemic infections 5
   • Consider using clinical scoring systems (Centor, McIsaac, FeverPAIN) to assess risk of bacterial pharyngitis 1, 5

2. Symptomatic treatment:

   • Systemic analgesics: ibuprofen (preferred if no contraindications) or paracetamol 1, 2
   • Consider topical treatments as adjunctive therapy: local anesthetic sprays or lozenges for additional symptom relief 3, 6
   • Local anesthetics with confirmed efficacy include lidocaine (8mg), benzocaine (8mg), and ambroxol (20mg) 6
   • Flurbiprofen 8.75mg spray has shown efficacy in providing rapid and long-lasting relief from sore throat symptoms 7

3. Antibiotic considerations:

   • Antibiotics should not be used in patients with less severe presentation of sore throat (0-2 Centor criteria) 1, 3
   • For patients with more severe presentations (3-4 Centor criteria), modest benefits of antibiotics must be weighed against side effects, impact on microbiota, antibiotic resistance, and costs 1, 3
   • If antibiotics are indicated, penicillin V twice or three times daily for 10 days is recommended 1

Important Considerations and Pitfalls

• Local antibiotics or antiseptics are not recommended for sore throat treatment due to the mainly viral origin of sore throats and lack of efficacy data 2, 6
• Corticosteroids are not routinely recommended for sore throat treatment in self-care settings, but may be considered in conjunction with antibiotic therapy for adults with severe presentations (3-4 Centor criteria) 1, 3
• Zinc gluconate is not recommended for sore throat treatment due to conflicting efficacy results and increased adverse effects 1, 2
• There is inconsistent evidence supporting the efficacy of alternative treatments such as herbal remedies or acupuncture for sore throat 1, 3
• Acute sore throat is usually self-limiting with a mean duration of 7 days; patients should be encouraged in self-management 5

Special Populations

• Both ibuprofen and paracetamol are effective for sore throat symptoms in children, with no significant difference in analgesic efficacy or safety between the two 2, 3
• For patients with high risk of bacterial infection, rapid antigen testing with culture of negative results is recommended for appropriate management 8